Meta-analysis On The Incidence Of Advanced Adenoma Of The Colorectal In Different Risk Groups

Objective:Meta analysis was executed on the relevant papers of patients at different risks who were found to have advanced adenoma by endoscope review within five years after endoscope filtrating.The differences in the incidence of advanced adenoma in patients at different risks within five years after colonoscopy surveillance and follow-up were systematically evaluated.Appropriate monitoring intervals were determined according to different risk groups.Materials and methods:Read related literature in both Chinese and English and formulate search terms.Chinese search subject:"colonoscopy or endoscope;Surveillance or follow-up;Adenoma or polyp.English search keywords:"Colonoscopy or Colonoscopies;Surveillance or follow up;Adenoma~*or polyp~*".In the searching process,relevant literatures were retrieved in strict accordance with the PICOS principle,in which P(Patient/population)represents the clinical characteristics of cases.I(Intervention/exposure)refers to the Intervention measures or exposure factors selected in the study.C(comparition)refers to the comparative measures adopted by the research;O(outcome)refers to the outcome index obtained by the research;S(study)refers to the type of design developed by research.Chinese search CNKI resource library,WanFang data knowledge service platform,China biomedical document service system(SinoMed).Foreign language retrieval PubMed database,Elsevier ScienceDirect,EBSCO retrieval platform.All the retrieved literatures were imported into NoteExpress document management software,duplicate articles were eliminated,and other literatures that met the requirements were screened strictly on the basis of the build inclusion and elimination standard by the two researchers.During the screening stage,if the two researchers disagree on the inclusion or exclusion of the literature,a third investigator decides.The researchers extracted data from the finally included and qualified literatures,and used the newcastle-ottawa Scale(NOS)to evaluate the quality of the included literatures.Meta-analysis was executed with RevMan5.2.On the basis of the included perspective studies and case-control studies,appropriate monitoring intervals for different risk groups were evaluated by combining the incidence of progressive adenomas in the no adenoma,low-risk adenoma,and high-risk adenoma groups.Results:A total of 21159 patients,including 8765 in the risk-free group,7926 in the low-risk group,and 4468 in the high-risk group,were included in 13 articles that satisfied the inclusion and exclusion criteria.In the 13 studies,the mean age was over 49 years old,mainly male,and the mean surveillance time was more than 2years.Based on the systematic evaluation of the number of people at risk for outcome indicator progression adenomas,appropriate follow-up intervals should be established for different risk groups.The incidence of advanced adenoma in the low-risk group was slightly higher than that in the risk-free group(OR=2.03,95%CI:1.45-2.85,I~2=58%,P<0.0001).The incidence of advanced adenoma in the high-risk group was significantly higher than that in the risk-free group(OR=6.15,95%CI:5.05-7.47,I~2=41%,P<0.00001).The incidence of advanced adenoma in the high-risk group was higher than that in the low-risk group(OR=2.38,95%CI:1.85-3.06,I~2=64%,P<0.00001).Conclusion:The incidence of advanced adenoma within 5 years in HRA groups was significantly higher than that in NA groups,and higher than that in LRA groups.The incidence of advanced adenoma within 5 years in LRA groups was slightly higher than that in NA groups,with slight difference.It is recommended that the colonoscopy should be reviewed within three years for HRA groups,within five years for LRA groups,and more than five years for NA groups.